Radiofrequency Catheter Ablation of Ventricular Tachycardia in a Case of Arrhythmogenic Right Ventricular Dysplasia

A 39-year old man was admitted to the hospital with sustained ventricular tachycardia. He had a history of syncope before admisson and was diagnosed to have an arrhythmogenic right ventricular dysplasia. His ventricular tachycardia (VT) was refractory to six antiarrhythmic drugs alone or in combination. Radiofrequency (RF) current was used to ablate the VT. Sustained monomorphic ventricular tachycardia was induced with single ventricular extrastimuli during electrophysiologic study. Earliest endocardial activation was mapped to the anterolateral region of the right ventricular outlow tract. A RF energy was delivered at 50 W for a 60 second period. At the fifth second, a sinus rhythm was restored. A control electrophysiologic study demonstrated inability to induce a VT with 1 to 4 extrastimuli, burst and decremental pacing. During a follow-up of 2.5 months period without medical therapy intermittent Holter monitoring failed to reveal neither sustained nor nonsustained VT attack. VT was apparently eliminated successfully with RF ablation.